Fractional exhaled nitric oxide levels as a predictor of long-term prognoses in patients with mild asthma.

BACKGROUND: There is a growing belief that patients with bronchial asthma (BA) should be provided an individualized and optimized treatment plan. We aimed to clarify the predictors of long-term prognoses in patients with mild BA. METHODS: We conducted a retrospective study of consecutive patients who were newly diagnosed with mild BA at Iwate Medical University from 2011 to 2013, focusing on achievement of full asthma control based on the Asthma Control Test as an indicator of prognosis. Predictors were identified on the basis of a chart review. RESULTS: Among 71 patients with mild BA, 37 patients completed regular clinic visits for 1 year. Nineteen (51.4%) of these patients achieved full asthma control. Current smoking and the fractional exhaled nitric oxide (FeNO) level at the first patient visit were identified by multivariate logistic regression as possible predictors of the discontinuation of clinic visits and achievement of full asthma control, respectively. Low FeNO levels at the first clinic visit yielded a receiver operating characteristic-area under the curve of 0.860 (95% confidence interval [CI]=0.774-0.975) for the achievement of full asthma control. Using an FeNO cut-off level of 34 parts per billion yielded a sensitivity of 76.5% (95% CI=59.5-88.2%) and specificity of 73.7% (95% CI=58.5-84.2%). CONCLUSION: Our preliminary results suggested that patients with newly diagnosed mild BA who display higher FeNO levels at their first clinic visits should be appropriately educated during early visits to receive optimal treatment and complete regular clinic visits.

Cerebral air embolism treated with hyperbaric oxygen therapy following percutaneous transthoracic computed tomography-guided needle biopsy of the lung.

A 71-year-old man presented with cough and sputum for 12 months. Chest radiography showed a homogeneous opacity in the right lower lobe. Computed tomography (CT) showed a nodular opacity, 2 cm in diameter, in the posterior segment of the right lower lobe. Mild emphysematous changes were also seen. With the patient in a prone position, a 19-gauge 7.8-cm introducer was placed in the lesion during a single inspiratory breath-hold. A coaxial 20-gauge automated needle was inserted through the introducer using a biopsy gun. Although the patient did not complain of any symptoms, postbiopsy CT showed air in the left ventricle and ascending aorta. After 5 h of bed rest, we found weakness in his left lower extremity. He was transferred to a hyperbaric oxygen chamber and recovered the next day. Air embolism is a rare, potentially fatal complication of percutaneous lung biopsy. Although the true effect of hyperbaric oxygen therapy is controversial, knowledge regarding the prompt management of such cases may help radiologists who perform this procedure.

[Cytoprotective effects of heat shock protein-70 in bronchial epithelium against neutrophil elastase-induced cell injury].

BACKGROUND: Neutrophil releases several mediators during inflammation, including neutrophil elastase (NE) that impairs bronchial epithelial function. The stress response and stress proteins protect cells against a variety of cytotoxic conditions. Accordingly, we tested the hypothesis that bronchial epithelial heat shock protein (Hsp-70) would protect a NE-induced cell injury. METHODS: Bronchial epithelial cells (BECs) obtained by bronchial brushing under bronchoscopy were cultured and used for experiments. Expression of Hsp-70 in BECs was confirmed by Western blot and flowcytometric analysis. To test Hsp-70 in BECs, induction of Hsp-70 protein into BECs was carried out by liposome-based delivery system. Introduction of Hsp-70 into BECs were examined by direct fluorescence microscope examination and flowcytometric analysis. NE-induced cytotoxicity was evaluated by cell culture supernatant LDH assay and cell detachment assay. RESULTS: Higher expressions of Hsp-70 were observed in BECs, which were induced by sodium arsenite. Over expression of Hsp-70 in BECs reduced NE-induced cell injury. Introduction of Hsp-70 protein into BECs by liposomal delivery decreased LDH release, and inhibited necrosis and apoptosis of the cells by NE as compared to untreated control. CONCLUSION: These data suggested that Hsp-70 in BECs may inhibit NE-induced airway epithelial damage. Liposomal delivery of Hsp-70 into BECs may be a possible means of protecting bronchial epithelium against inflammatory airway diseases including acute and chronic bronchitis.